水摄取率在急性小脑梗死不良预后的预测作用  

The Predictive Role of Water Uptake Rate in Poor Prognosis of Acute Cerebellar Infarction

作　　者：张艳芳[1] 滕继军[1] 

机构地区：[1]青岛大学医学院附属医院神经内科,山东 青岛

出　　处：《临床医学进展》2024年第5期1935-1947,共13页Advances in Clinical Medicine

摘　　要：目的:早期识别具有神经系统恶化风险的急性小脑梗死患者仍然是一个临床难题。每脑体积的净水摄取(Net Water Uptake Rate, NWU)是一种可在CT上测量的缺血性水肿的定量影像学生物标志物,但这种生物标志物目前仅应用于评价前循环卒中的患者。我们假设梗死病灶早期的NWU可以预测急性小脑梗死患者不良预后的发生。本研究的目的是比较急性小脑梗死的NWU与其他常见的预测因素。方法:连续性收集2013年3月~2022年10月在青岛大学附属医院神经内科住院的急性小脑梗死患者,按照纳入及排除标准筛选,回顾性收集基线资料。根据住院期间的最终结局,将患者分为预后良好组和预后不良组。“良好预后”被定义为经内科保守治疗,症状好转。而“不良预后”被定义为符合下列条件之一:1) 住院期间死亡;2) 美国国立卫生院卒中量表(NIHSS评分)第Ia项意识水平下降至1分或更高,且未发现其他继发恶性原因;3) 入院时或住院期间行后颅窝减压术和/或侧脑室外引流术;4) 住院期间出现神经功能恶化,需要手术治疗,因各种原因拒绝手术治疗,且出院时需要长期护理或需临终关怀患者。对所有研究对象进行出院后30天病情随访,以出院后30天内是否死亡为评判标准。使用SPSS 25.0统计软件进行分析,采用多因素Logistic回归分析与神经系统恶化风险相关的独立危险因素。基于发病24小时内颅脑CT,应用标准化程序来量化每早期梗死体积的水摄取率(NWU),即通过密度测量(Dischemic)患侧及健侧(Dnormal)灰度值,然后,应用公式计算NWU:公式[水摄取率(%) = 1 − 患侧灰度值/健侧灰度值],计算各层面的平均值,得到最终的水摄取率。分析两组患者的特征并绘制受试者工作特征(ROC)曲线,以比较水摄取率及其他相关危险因素(四脑室受压变形、磁共振弥散加权成像(DWI)上的梗死体积等)的价值,分析NWU识别不�Objective: Early identification of patients with acute cerebellar infarction risking neurological deterioration remains a clinical challenge. Net Water Uptake Rate (NWU) per unit of brain volume is a quantitative imaging biomarker of ischemic edema measurable on CT, but this biomarker is currently only applied to evaluating patients with anterior circulation stroke. We hypothesize that early NWU in the infarction lesion can predict the occurrence of adverse outcomes in patients with acute cerebellar infarction. The purpose of this study is to compare NWU in acute cerebellar infarction with other common predictors. Methods: Acute cerebellar infarction patients admitted to the neurology department of the Affiliated Hospital of Qingdao University from March 2013 to October 2022 were continuously collected, and screened according to inclusion and exclusion criteria, and baseline data were retrospectively collected. Patients were divided into a good prognosis group and a poor prognosis group based on the final outcome during hospitalization. “Good prognosis” was defined as improvement of symptoms after conservative medical treatment. “Poor prognosis” was defined as meeting one of the following conditions: 1) Death during hospitalization;2) The level of consciousness on the National Institutes of Health Stroke Scale (NIHSS score) item Ia dropped to 1 point or higher, and no other secondary malignant causes were found;3) Posterior fossa decompression and/or ventricular drainage were performed at admission or during hospitalization;4) Neurological deterioration occurred during hospitalization, requiring surgical treatment, refusal of surgical treatment due to various reasons, and long-term care or end-of-life care was required at discharge. All subjects were followed up for 30 days after discharge, and whether death occurred within 30 days after discharge was used as the criterion for evaluation. SPSS 25.0 statistical software was used for analysis, and multifactorial Logistic regression analysis was performed to

关 键 词：小脑梗死 脑水肿 水摄取率 曲线下面积 手术干预 

分 类 号：R74[医药卫生—神经病学与精神病学]